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As part of VHA’s Diffusion of Excellence Initiative, the VHA Shark Tank Competition identifies field-developed promising practices and facilitates the standardization of those practices across the VA healthcare system. Submitted practices undergo evaluation by VA subject matter experts and compete for the opportunity to be one of 20 finalists who pitch their practices at the virtual competition to medical center and network directors. During the virtual competition, the leadership teams bid resources—such as money, staff, or time—to implement the practices they want in their facilities. VA senior leaders then select approximately 10 finalists and 10 network directors as winners.
All Gold Status practices will receive implementation consultation from QUERI (Quality Enhancement Research Initiative) implementation experts at this Fall’s Diffusion of Excellence Base Camp, coordinated in part by the QUERI Center for Evaluation and Implementation Resources.
All four HSR&D finalists in this year’s VA Shark Tank Competition—Drs. Matt Crowley, Susan N. Hastings, Judith Long, and Miriam Morey—have now achieved Gold Status, which means that they received bids from VA facilities during the Shark Tank competition held on August 30, 2018.
Matthew Crowley, MD, is a core investigator with HSR&D’s Center for Health Services Research in Primary Care in Durham, NC, and a VA HSR&D Career Development Awardee. He also is team leader for the “Advanced Comprehensive Diabetes Care (ACDC)” program, a nurse-administered telemedicine intervention for patients with persistently poor diabetes control. ACDC augments standard home telehealth services with diabetes self-management support and clinician-guided medication management. In the initial randomized trial at the Durham VA Medical Center, ACDC improved HbA1c by an average of 1% vs. usual care over a six-month period, and by nearly 2% among engaged Veterans. Critically, ACDC was specifically designed to use only existing VA staffing and infrastructure, so can be implemented feasibly as part of clinical practice. ACDC’s effectiveness in the “real world” has been confirmed at multiple VA sites where the intervention has been implemented.
Addressing VA’s priority category Care Coordination, the “Advanced Comprehensive Diabetes Care (ACDC)” program will be implemented within the VISN 19 Rocky Mountain Network, Montana VA Health Care System.
Susan N. Hastings, MD, is Director of HSR&D’s Center for Health Services Research in Primary Care, in Durham, NC, and is one of the Principal Investigators for the Optimizing Function and Independence QUERI national program, also located in Durham. She is the team leader for “Getting Hospitalized Veterans Back on Their Feet: The STRIDE Program,” which consists of a one-time gait and balance assessment conducted by a physical therapist, followed by daily supervised walks by a therapy or nursing assistant for the duration of the hospital stay. Program evaluation has demonstrated high satisfaction among Veteran participants and reduced need for post-acute institutional care. Outcome measures include reduced discharges to skilled nursing facilities, reduced length of hospital stay, and improved Veteran experience.
Addressing VA’s priority categories Quality and Safety – and Access, the ”Getting Hospitalized Veterans Back on Their Feet: The STRIDE Program” intervention will be implemented within the Wm. Jennings Bryan Dorn VA Medical Center in South Carolina and the Martinsburg VA Medical Center in West Virginia.
Judith Long, MD, is Co-Director of HSR&D’s Center for Health Equity Research and Promotion in Philadelphia and Pittsburgh, PA. She is the team leader for “Better Health, Lower Cost: How IMPaCT Community Health Workers Can Support Veterans.” For Veterans struggling with real-life challenges such as hunger, housing insecurity, or trauma, community health workers (CHWs) are trusted laypeople who share a common background (i.e., race, income, Veteran status) with their patients. Therefore, CHWs are well-positioned to build trust with fellow Veterans and address unmet social needs. IMPaCT consists of a standardized, evidence-based program in which CHWs are hired and trained to join healthcare teams and provide social support to high-risk patients. IMPaCT has been tested in three randomized controlled trials, including a recent multi-center trial involving chronically ill Veterans. These trials demonstrate consistent improvements in chronic disease control, mental health, and quality of care, and reductions in hospitalizations by 65%. To date, IMPaCT has been delivered to nearly 7,000 patients in the Philadelphia region, including 270 Veterans at the Corporal Michael J. Crescenz VA Medical Center. This standardized intervention to address the social determinants of health is an exciting means by which to improve patient-perceived quality of care while reducing hospitalizations.
Addressing VA’s priority category Quality and Safety, the ”Better Health, Lower Cost: How IMPaCT Community Health Workers Can Support Veterans” intervention will be implemented within the Iowa City Health Care System.
Miriam Morey, PhD, is Associate Director of the Durham VA Health Care System Geriatrics Research Education and Clinical Center. She is team leader for “Gerofit – Managing Diseases and Lowering Care Costs with Exercise,” an exercise and health promotion program that provides personally-tailored exercise programs for older Veterans. Gerofit supports facility-based programs, home-based counseling programs, and various modalities of hybrid outreach programs (e.g. Tele-Gerofit at CBOCs, Geriatric Walking Clinic, virtual-on- demand home exercise). Thus far, the Gerofit program has resulted in a 25%, 10-year reduced mortality rate and a reduced risk of institutionalization. Gerofit also has resulted in a significant reduction in Veterans’ cardio-metabolic risk profiles. In addition, Gerofit has reduced the numbers of prescribed medications following 12 months of exercise. For patients with PTSD, 86% of participants reported that participation in Gerofit improved their symptoms. The key outcome measures for the program include: reduced risk of institutionalization measured by improved physical function, reduced medication utilization; improved cardio-metabolic health, and improved mental health/well-being. Gerofit has been disseminated to 12 other Medical Care Systems with support from the VHA Offices of Geriatrics and Extended Care and Rural Health.
Addressing VA’s priority categories – Veteran Experience and Quality and Safety, the ”Gerofit – Managing Diseases and Lowering Care Costs with Exercise” intervention will be implemented within the Charlie Norwood VA Medical Center in Georgia.
